Mohid S Khan, Raj Srirajaskanthan, Aviva Frydman, D Mark Pritchard
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引用次数: 0
摘要
由于神经内分泌肿瘤(NENs)的发病率越来越高,内镜医师在进行诊断性上消化道(GI)内镜检查时越来越频繁地发现这些肿瘤。这些手术通常是为了无关的适应症或筛查而进行的,肿瘤往往是偶然发现的。最常见的情况是,内镜医师在对最初被认为是良性的小息肉进行活检后,意外地收到了分化良好的神经内分泌肿瘤(NET)的组织学报告。本文旨在为这种情况下的下一步工作提供一些指导。不过,所有NET患者都应转诊到一个完整的NEN多学科团队,接受明确的检查和治疗。一般来说,在最初的内窥镜检查中,应对任何可能的NEN的部位、大小和数量进行全面评估,并拍摄具有代表性的内窥镜图像。如果初次内窥镜评估不充分,可能需要重复检查。应使用活检钳对可能存在的 NEN 取样。只有在组织学确诊和肿瘤分级,并进行了其他检查以对肿瘤进行全面分期并确定其激素分泌状况后,才能尝试进行内窥镜切除术。这一点至关重要,以免患者接受不必要或不适当的内镜切除术。本文将讨论发生在胃、十二指肠、回肠末端和直肠的 NEN 的内窥镜特征和后续评估,因为这些部位是消化道内常见的肿瘤部位。
Neuroendocrine tumours found at endoscopy: diagnosis and staging
Due to their increasing incidence, neuroendocrine neoplasms (NENs) are being detected more frequently by endoscopists while they are performing diagnostic upper or lower gastrointestinal (GI) endoscopies. These procedures are usually performed for unrelated indications or for screening, with the tumours often being detected incidentally. The most common scenario is of an endoscopist being surprised by receiving a histology report of a well-differentiated neuroendocrine tumour (NET) after biopsying a small polyp that was initially thought to be benign. This article aims to provide some guidance about what to do next in that situation. All patients with NET should, however, be referred to a fully constituted NEN multidisciplinary team for definitive investigations and management. In general, the site, size and number of any possible NENs should be fully assessed during the initial endoscopy and representative endoscopic images should be captured. If the initial endoscopic assessment was inadequate, the procedure may need to be repeated. Possible NENs should be sampled using biopsy forceps. Endoscopic resection should only be attempted following histological confirmation of the diagnosis and tumour grade and after additional investigations have been performed to fully stage the tumour and determine its hormone production status. This is essential so that patients do not undergo either unnecessary or inadequate endoscopic resections. This article discusses the endoscopic features and subsequent assessment of NENs that arise in the stomach, duodenum, terminal ileum and rectum, as these are the common tumour sites within the GI tract.
期刊介绍:
Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.